TY - JOUR AU - Ullrich, Greta AU - Bäuerle, Alexander AU - Vogt, Hannah AU - Mahabadi, Abbas Amir AU - Paldán, Katrin AU - Messiha, Daniel AU - Jahre, Maria Lisa AU - Rammos, Christos AU - Rassaf, Tienush AU - Lortz, Julia PY - 2025/3/19 TI - Digital Health Literacy and Attitudes Toward eHealth Technologies Among Patients With Cardiovascular Disease and Their Implications for Secondary Prevention: Survey Study JO - JMIR Form Res SP - e63057 VL - 9 KW - cardiovascular diseases KW - telemedicine KW - eHealth KW - patient-centered approach KW - digital health literacy KW - digital health KW - cardiovascular disease KW - mortality KW - artery disease KW - ischemic KW - heart disease KW - diabetes mellitus KW - obesity KW - patient education KW - eHealth literacy KW - mobile phone N2 - Background: Cardiovascular disease is the major cause of death worldwide, leading to a significant socioeconomic burden. Although secondary prevention is a cornerstone in chronic disease management, adherence to guideline recommendations in this regard often falters, leading to suboptimal outcomes. While eHealth technologies are promising for improving treatment adherence, they also represent a new approach to secondary prevention. However, a common critique is that extensive digitalization may not adequately address the needs of older adults with chronic medical conditions. Objective: This study aims to analyze eHealth literacy, digital use patterns, and general attitudes toward digital technologies in a collective of patients with cardiovascular disease to identify potential obstacles in implementing mobile health technologies in secondary preventive therapy. Methods: This survey-based study was a part of the baseline examination of the PreventiPlaque trial. It involved 240 participants with known coronary artery disease. The assessment evaluated their current understanding of the general use of digital devices. The questionnaire covered aspects such as the duration of daily use, personal attitudes, and the perceived burden associated with digital media. eHealth literacy was assessed within the target population and general demographic data were gathered, focusing on cardiovascular comorbidities and risk factors. Results: The analysis revealed an average age of 61.9 (SD 8.9) years, with 59.9% (n=144) of the participants being male. Overall, 37.3% (n=90) of the participants had previous knowledge of digital health interventions, while only 17.8% (n=41) had used them. Despite the generally low practical application within this study population, there was a high level of confidence in handling digital devices, with 61.9% (n=149) expressing themselves as either rather confident or very confident. Regarding the levels of eHealth literacy among the participants, 71.2% (n=170) claimed to be familiar with locating health information on the internet, and 64% (n=153) of participants felt capable of critically evaluating its quality. These levels of digital confidence were consistent across all age groups. Moreover, internet use rates remained high even among the older participants, with 80% (n=192) of those participants older than 75 years using the internet for 1-3 hours a day. Conclusions: The study unveiled a notable confidence level among participants regarding the use of digital devices, coupled with a favorable attitude toward digital media evident across all age brackets. Remarkably, internet use rates remained high, even among older participants. The actual utilization of digital health interventions was relatively low, potentially stemming from challenges in locating reliable sources. These findings emphasize the prospect of future eHealth interventions customized to the distinct needs and preferences of patients in cardiovascular disease management. Recognizing the incongruity between confidence in device use and the restricted adoption of digital health tools can guide the development of focused interventions to narrow this divide. Trial Registration: ClinicalTrials.gov NCT05096637; https://clinicaltrials.gov/study/NCT05096637 UR - https://formative.jmir.org/2025/1/e63057 UR - http://dx.doi.org/10.2196/63057 ID - info:doi/10.2196/63057 ER - TY - JOUR AU - Abdullayev, Kamilla AU - Chico, A. Tim J. AU - Canson, Jiana AU - Mantelow, Matthew AU - Buckley, Oli AU - Condell, Joan AU - Van Arkel, J. Richard AU - Diaz-Zuccarini, Vanessa AU - Matcham, Faith PY - 2025/3/5 TI - Exploring Stakeholder Perspectives on the Barriers and Facilitators of Implementing Digital Technologies for Heart Disease Diagnosis: Qualitative Study JO - JMIR Cardio SP - e66464 VL - 9 KW - heart disease KW - digital technologies KW - stakeholder perspectives KW - qualitative research KW - digital technology KW - health technology KW - heart KW - cardio KW - cardiology KW - cardiovascular KW - qualitative KW - focused group KW - quality of care KW - efficiency KW - digital health KW - mobile phone KW - artificial intelligence KW - AI N2 - Background: Digital technologies are increasingly being implemented in health care to improve the quality and efficiency of care for patients. However, the rapid adoption of health technologies over the last 5 years has failed to adequately consider patient and clinician needs, which results in ineffective implementation. There is also a lack of consideration for the differences between patient and clinician needs, resulting in overgeneralized approaches to the implementation and use of digital health technologies. Objective: This study aimed to explore barriers and facilitators of the implementation of digital technologies in the diagnosis of heart disease for both patients and clinicians, and to provide recommendations to increase the acceptability of novel health technologies. Methods: We recruited 32 participants from across the United Kingdom, including 23 (72%) individuals with lived experience of heart disease and 9 (28%) clinicians involved in diagnosing heart disease. Participants with experience of living with heart disease took part in semistructured focused groups, while clinicians contributed to one-to-one semistructured interviews. Inductive thematic analysis using a phenomenological approach was conducted to analyze the resulting qualitative data and to identify themes. Results were discussed with a cardiovascular patient advisory group to enhance the rigor of our interpretation of the data. Results: Emerging themes were separated into facilitators and barriers and categorized into resource-, technology-, and user-related themes. Resource-related barriers and facilitators related to concerns around increased clinician workload, the high cost of digital technologies, and systemic limitations within health care systems such as outdated equipment and limited support. Technology-related barriers and facilitators included themes related to reliability, accuracy, safety parameters, data security, ease of use, and personalization, all of which can impact engagement and trust with digital technologies. Finally, the most prominent themes were the user-related barriers and facilitators, which encompassed user attitudes, individual-level variation in preferences and capabilities, and impact on quality of health care experiences. This theme captured a wide variety of perspectives among the sample and revealed how patient and clinician attitudes and personal experiences substantially impact engagement with digital health technologies across the cardiovascular care pathway. Conclusions: Our findings highlight the importance of considering both patient and clinician needs and preferences when investigating the barriers and facilitators to effective implementation of digital health technologies. Facilitators to technology adoption include the need for cost-effective, accurate, reliable, and easy-to-use systems as well as adequate setup support and personalization to meet individual needs. Positive user attitudes, perceived improvement in care quality, and increased involvement in the care process also enhance engagement. While both clinicians and patients acknowledge the potential benefits of digital technologies, effective implementation hinges on addressing these barriers and leveraging facilitators to ensure that the technologies are perceived as useful, safe, and supportive of health care outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-072952 UR - https://cardio.jmir.org/2025/1/e66464 UR - http://dx.doi.org/10.2196/66464 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053721 ID - info:doi/10.2196/66464 ER - TY - JOUR AU - Carr, James Zyad AU - Agarkov, Daniel AU - Li, Judy AU - Charchaflieh, Jean AU - Brenes-Bastos, Andres AU - Freund, Jonah AU - Zafar, Jill AU - Schonberger, B. Robert AU - Heerdt, Paul PY - 2025/2/17 TI - Implementation of Brief Submaximal Cardiopulmonary Testing in a High-Volume Presurgical Evaluation Clinic: Feasibility Cohort Study JO - JMIR Perioper Med SP - e65805 VL - 8 KW - preoperative evaluation KW - submaximal cardiopulmonary exercise test KW - risk stratification KW - perioperative medicine KW - anesthesiology N2 - Background: Precise functional capacity assessment is a critical component for preoperative risk stratification. Brief submaximal cardiopulmonary exercise testing (smCPET) has shown diagnostic utility in various cardiopulmonary conditions. Objective: This study aims to determine if smCPET could be implemented in a high-volume presurgical evaluation clinic and, when compared to structured functional capacity surveys, if smCPET could better discriminate low functional capacity (?4.6 metabolic equivalents [METs]). Methods: After institutional approval, 43 participants presenting for noncardiac surgery who met the following inclusion criteria were enrolled: aged 60 years and older, a Revised Cardiac Risk Index of ?2, and self-reported METs of ?4.6 (self-endorsed ability to climb 2 flights of stairs). Subjective METs assessments, Duke Activity Status Index (DASI) surveys, and a 6-minute smCPET trial were conducted. The primary end points were (1) operational efficiency, based on the time of the experimental session being ?20 minutes; (2) modified Borg survey of perceived exertion, with a score of ?7 indicating no more than moderate exertion; (3) high participant satisfaction with smCPET task execution, represented as a score of ?8 (out of 10); and (4) high participant satisfaction with smCPET scheduling, represented as a score of ?8 (out of 10). Student's t test was used to determine the significance of the secondary end points. Correlation between comparable structured surveys and smCPET measurements was assessed using the Pearson correlation coefficient. A Bland-Altman analysis was used to assess agreement between the methods. Results: The mean session time was 16.9 (SD 6.8) minutes. The mean posttest modified Borg survey score was 5.35 (SD 1.8). The median patient satisfaction (on a scale of 1=worst to 10=best) was 10 (IQR 10-10) for scheduling and 10 (IQR 9-10) for task execution. Subjective METs were higher when compared to smCPET equivalents (extrapolated peak METs; mean 7.6, SD 2.0 vs mean 6.7, SD 1.8; t42=2.1; P<.001). DASI-estimated peak METs were higher when compared to smCPET peak METs (mean 8.8, SD 1.2 vs mean 6.7, SD 1.8; t42=7.2; P<.001). DASI-estimated peak oxygen uptake was higher than smCPET peak oxygen uptake (mean 30.9, SD 4.3 mL kg?1 min?1 vs mean 23.6, SD 6.5 mL kg?1 min?1; t42=7.2; P<.001). Conclusions: Implementation of smCPET in a presurgical evaluation clinic is both patient centered and clinically feasible. Brief smCPET measures, supportive of published reports regarding low sensitivity of provider-driven or structured survey measures for low functional capacity, were lower than those from structured surveys. Future studies will analyze the prediction of perioperative complications and cost-effectiveness. Trial Registration: ClinicalTrials.gov NCT05743673; https://clinicaltrials.gov/study/NCT05743673 UR - https://periop.jmir.org/2025/1/e65805 UR - http://dx.doi.org/10.2196/65805 UR - http://www.ncbi.nlm.nih.gov/pubmed/39773953 ID - info:doi/10.2196/65805 ER - TY - JOUR AU - Ramasawmy, Mel AU - Roland Persson, Dan AU - Sunkersing, David AU - Gill, Paramjit AU - Khunti, Kamlesh AU - Poole, Lydia AU - Hanif, Wasim AU - Blandford, Ann AU - Sajid, Madiha AU - Stevenson, Fiona AU - Khan, Nushrat AU - Banerjee, Amitava PY - 2024/10/24 TI - Uptake of Digital Health Interventions for Cardiometabolic Disease in British South Asian Individuals: Think Aloud Study JO - JMIR Hum Factors SP - e57338 VL - 11 KW - digital health KW - cardiometabolic disease KW - cardiology KW - cardiovascular risk KW - health inequality KW - health disparity KW - usability KW - user experience KW - think aloud KW - cultural barriers KW - digital divide KW - digital literacy N2 - Background: Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Objective: Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Methods: Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted ?think-aloud? interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Results: Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. Conclusions: DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs. UR - https://humanfactors.jmir.org/2024/1/e57338 UR - http://dx.doi.org/10.2196/57338 ID - info:doi/10.2196/57338 ER - TY - JOUR AU - Niyomyart, Atsadaporn AU - Ruksakulpiwat, Suebsarn AU - Benjasirisan, Chitchanok AU - Phianhasin, Lalipat AU - Nigussie, Kabtamu AU - Thorngthip, Sutthinee AU - Shamita, Gazi AU - Thampakkul, Jai AU - Begashaw, Lidya PY - 2024/8/22 TI - Current Status of Barriers to mHealth Access Among Patients With Stroke and Steps Toward the Digital Health Era: Systematic Review JO - JMIR Mhealth Uhealth SP - e54511 VL - 12 KW - digital health KW - mHealth KW - barrier KW - stroke KW - systematic review KW - mobile phones N2 - Background: Mobile health (mHealth) offers significant benefits for patients with stroke, facilitating remote monitoring and personalized health care solutions beyond traditional settings. However, there is a dearth of comprehensive data, particularly qualitative insights, on the barriers to mHealth access. Understanding these barriers is crucial for devising strategies to enhance mHealth use among patients with stroke. Objective: This study aims to examine the recent literature focusing on barriers to mHealth access among patients with stroke. Methods: A systematic search of PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text was conducted for literature published between 2017 and 2023. Abstracts and full texts were independently screened based on predetermined inclusion and exclusion criteria. Data synthesis was performed using the convergent integrated analysis framework recommended by the Joanna Briggs Institute. Results: A total of 12 studies met the inclusion criteria. The majority were qualitative studies (about 42%), followed by mixed methods (25%), pilot studies (about 17%), nonrandomized controlled trials (about 8%), and observational studies (about 8%). Participants included patients with stroke, caregivers, and various health care professionals. The most common mHealth practices were home-based telerehabilitation (30%) and poststroke mHealth and telecare services (20%). Identified barriers were categorized into two primary themes: (1) at the patient level and (2) at the health provider-patient-device interaction level. The first theme includes 2 subthemes: health-related issues and patient acceptability. The second theme encompassed 3 subthemes: infrastructure challenges (including software, networking, and hardware), support system deficiencies, and time constraints. Conclusions: This systematic review underscores significant barriers to mHealth adoption among patients with stroke. Addressing these barriers in future research is imperative to ensure that mHealth solutions effectively meet patients? needs. UR - https://mhealth.jmir.org/2024/1/e54511 UR - http://dx.doi.org/10.2196/54511 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54511 ER - TY - JOUR AU - Melnikov, Semyon AU - Klein, Stav AU - Shahar, Moni AU - Guy, David PY - 2024/8/13 TI - Using Topic Modeling to Understand Patients? and Caregivers? Perspectives About Left Ventricular Assist Device: Thematic Analysis JO - J Med Internet Res SP - e50009 VL - 26 KW - left ventricular assist device KW - LVAD KW - topic modeling KW - health care forum KW - heart disease KW - cardiovascular condition KW - medical devices KW - devices for heart KW - latent Dirichlet allocation KW - cardiovascular KW - device KW - visualization tool KW - tool KW - heart KW - caregiver KW - monitoring KW - management KW - care KW - users KW - communication KW - heart failure N2 - Background: Heart failure (HF) is a significant global clinical and public health challenge, impacting 64.3 million individuals worldwide. To address the scarcity of donor organs, left ventricular assist device (LVAD) implantation has become a crucial intervention for managing end-stage HF, serving as a bridge to heart transplantation or as a destination therapy. Web-based health forums, such as MyLVAD.com, play a vital role as trusted sources of information for individuals with HF symptoms and their caregivers. Objective: We aim to uncover the latent topics within the posts shared by users on the MyLVAD.com website. Methods: Using the latent Dirichlet allocation algorithm and a visualization tool, our objective was to uncover latent topics within the posts shared on the MyLVAD.com website. Through the application of topic modeling techniques, we analyzed 459 posts authored by recipients of LVAD and their family members from 2015 to 2023. Results: This study unveiled 5 prominent themes of concern among patients with LVAD and their family members. These themes included family support (39.5% weight value), encompassing subthemes such as family caregiving roles and emotional or practical support; clothing (23.9% weight value), with subthemes related to comfort, normalcy, and functionality; infection (18.2% weight value), covering driveline infections, prevention, and care; power (12% weight value), involving challenges associated with power dependency; and self-care maintenance, monitoring, and management (6.3% weight value), which included subthemes such as blood tests, monitoring, alarms, and device management. Conclusions: These findings contribute to a better understanding of the experiences and needs of patients implanted with LVAD, providing valuable insights for health care professionals to offer tailored support and care. By using latent Dirichlet allocation to analyze posts from the MyLVAD.com forum, this study sheds light on key topics discussed by users, facilitating improved patient care and enhanced patient-provider communication. UR - https://www.jmir.org/2024/1/e50009 UR - http://dx.doi.org/10.2196/50009 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50009 ER - TY - JOUR AU - Buhr, Lorina AU - Kaufmann, Martiana Pauline Lucie AU - Jörß, Katharina PY - 2022/8/3 TI - Attitudes of Patients With Chronic Heart Failure Toward Digital Device Data for Self-documentation and Research in Germany: Cross-sectional Survey Study JO - JMIR Cardio SP - e34959 VL - 6 IS - 2 KW - mobile health KW - mHealth KW - digital devices KW - wearables KW - heart failure KW - data sharing KW - consent KW - mobile phone N2 - Background: In recent years, the use of digital mobile measurement devices (DMMDs) for self-documentation in cardiovascular care in Western industrialized health care systems has increased. For patients with chronic heart failure (cHF), digital self-documentation plays an increasingly important role in self-management. Data from DMMDs can also be integrated into telemonitoring programs or data-intensive medical research to collect and evaluate patient-reported outcome measures through data sharing. However, the implementation of data-intensive devices and data sharing poses several challenges for doctors and patients as well as for the ethical governance of data-driven medical research. Objective: This study aims to explore the potential and challenges of digital device data in cardiology research from patients? perspectives. Leading research questions of the study concerned the attitudes of patients with cHF toward health-related data collected in the use of digital devices for self-documentation as well as sharing these data and consenting to data sharing for research purposes. Methods: A cross-sectional survey of patients of a research in cardiology was conducted at a German university medical center (N=159) in 2020 (March to July). Eligible participants were German-speaking adult patients with cHF at that center. A pen-and-pencil questionnaire was sent by mail. Results: Most participants (77/105, 73.3%) approved digital documentation, as they expected the device data to help them observe their body and its functions more objectively. Digital device data were believed to provide cognitive support, both for patients? self-assessment and doctors? evaluation of their patients? current health condition. Interestingly, positive attitudes toward DMMD data providing cognitive support were, in particular, voiced by older patients aged >65 years. However, approximately half of the participants (56/105, 53.3%) also reported difficulty in dealing with self-documented data that lay outside the optimal medical target range. Furthermore, our findings revealed preferences for the self-management of DMMD data disclosed for data-intensive medical research among German patients with cHF, which are best implemented with a dynamic consent model. Conclusions: Our findings provide potentially valuable insights for introducing DMMD in cardiovascular research in the German context. They have several practical implications, such as a high divergence in attitudes among patients with cHF toward different data-receiving organizations as well as a large variance in preferences for the modes of receiving information included in the consenting procedure for data sharing for research. We suggest addressing patients? multiple views on consenting and data sharing in institutional normative governance frameworks for data-intensive medical research. UR - https://cardio.jmir.org/2022/2/e34959 UR - http://dx.doi.org/10.2196/34959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35921134 ID - info:doi/10.2196/34959 ER - TY - JOUR AU - Chen, Huey Sheau AU - Edwards, Iain AU - Jayasena, Rajiv AU - Ding, Hang AU - Karunanithi, Mohanraj AU - Dowling, Alison AU - Layland, Jamie AU - Maiorana, Andrew PY - 2021/9/14 TI - Patient Perspectives on Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure (ITEC-CHF): Usability Study JO - JMIR Cardio SP - e24611 VL - 5 IS - 2 KW - chronic heart failure KW - telemonitoring KW - usability KW - acceptance KW - patient perspectives N2 - Background: Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but little is known about the usability and patients? willingness to engage with this technology. Objective: This study aims to evaluate feedback from patients with CHF following participation in the Innovative Telemonitoring Enhanced Care program for CHF (ITEC-CHF) study. Methods: The telemonitoring intervention consisted of three components: remote weight monitoring, structured telephone support, andnurse-led collaborative care. Participants were provided with electronic weighing scales (W550; ForaCare), and a computer tablet (Galaxy Tab A; Samsung). They were asked to weigh themselves on the provided scales daily. Telemonitoring was integrated with a personal assistance call service and a nurse care service according to their workflows in usual care. Feedback on the usability of ITEC-CHF was collected via survey from study participants following 6 months of receiving telemonitoring care for their body weight. Survey responses were provided on a 5-point Likert scale and through open-ended questions to determine participants? perceived benefits and barriers to using ITEC-CHF. Results: A total of 67 participants (49/67, 73% male), with a mean age of 69.8 (SD 12.4) years completed the survey. The majority of participants agreed or strongly agreed that the ITEC-CHF program was easy to use (61/67, 91%), easy to navigate (51/65, 78%), useful (59/65, 91%), and made them feel more confident in managing their weight (57/67, 85%). Themes related to participants? perceptions of telemonitoring included increased support for early intervention of clinical deterioration, improved compliance to daily weighing, a sense of reassurance, and improved self-care and accountability, among others. Conclusions: ITEC-CHF was rated highly on usability and was well accepted by users as part of their routine self-management activities. Participants were willing to use telemonitoring because they perceived a broad spectrum of benefits for CHF management. Trial Registration: Australian New Zealand Clinical Trial Registry ID ACTRN 12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691. UR - https://cardio.jmir.org/2021/2/e24611 UR - http://dx.doi.org/10.2196/24611 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519663 ID - info:doi/10.2196/24611 ER - TY - JOUR AU - Kapoor, Alok AU - Andrade, Andreza AU - Hayes, Anna AU - Mazor, Kathleen AU - Possidente, Carl AU - Nolen, Kim AU - Hegeman-Dingle, Rozelle AU - McManus, David PY - 2021/2/24 TI - Usability, Perceived Usefulness, and Shared Decision-Making Features of the AFib 2gether Mobile App: Protocol for a Single-Arm Intervention Study JO - JMIR Res Protoc SP - e21986 VL - 10 IS - 2 KW - shared decision making KW - mobile health KW - stroke risk KW - anticoagulation risk KW - anticoagulation education KW - atrial fibrillation KW - anticoagulation therapy KW - anticoagulation KW - atrial flutter KW - mobile phone N2 - Background: The Centers for Disease Control and Prevention has estimated that atrial fibrillation (AF) affects between 2.7 million and 6.1 million people in the United States. Those who have AF tend to have a much higher stroke risk than others. Although most individuals with AF benefit from anticoagulation (AC) therapy, a significant majority are hesitant to start it. To add, providers often struggle in helping patients negotiate the decision to start AC therapy. To assist in the communication between patients and providers regarding preferences and knowledge about AC therapy, different strategies are being used to try and solve this problem. In this research study, we will have patients and providers utilize the AFib 2gether app with hopes that it will create a platform for shared decision making regarding the prevention of stroke in patients with AF receiving AC therapy. Objective: The aim of our study is to measure several outcomes related to encounters between patients and their cardiology providers where AFib 2gether is used. These outcomes include usability and perceived usefulness of the app from the perspective of patients and providers. In addition, we will assess the extent and nature of shared decision making. Methods: Eligible patients and providers will evaluate the AFib 2gether mobile app for usability and perceived usefulness in facilitating shared decision making regarding understanding the patient?s risk of stroke and whether or not to start AC therapy. Both patients and providers will review the app and complete multiple questionnaires about the usability and perceived usefulness of the mobile app in a clinical setting. We will also audio-record a subset of encounters to assess for evidence of shared decision making. Results: Enrollment in the AFib 2gether shared decision-making study is still ongoing for both patients and providers. The first participant enrolled on November 22, 2019. Analysis and publishing of results are expected to be completed in spring 2021. Conclusions: The AFib 2gether app emerged from a desire to increase the ability of patients and providers to engage in shared decision making around understanding the risk of stroke and AC therapy. We anticipate that the AFib 2gether mobile app will facilitate patient discussion with their cardiologist and other providers. Additionally, we hope the study will help us identify barriers that providers face when placing patients on AC therapy. We aim to demonstrate the usability and perceived usefulness of the app with a future goal of testing the value of our approach in a larger sample of patients and providers at multiple medical centers across the country. Trial Registration: ClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270 International Registered Report Identifier (IRRID): DERR1-10.2196/21986 UR - https://www.researchprotocols.org/2021/2/e21986 UR - http://dx.doi.org/10.2196/21986 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625361 ID - info:doi/10.2196/21986 ER - TY - JOUR AU - Schenck-Gustafsson, Karin AU - Carnlöf, Carina AU - Jensen-Urstad, Mats AU - Insulander, Per PY - 2021/2/18 TI - Improving Efficiency of Clinical Studies Using a Total Digital Approach: Prospective Observational Study JO - JMIR Form Res SP - e18385 VL - 5 IS - 2 KW - ECG recordings KW - women KW - palpitations KW - full digitalization KW - eAuthentication KW - BankID KW - clinical trial KW - mHealth KW - electrocardiogram N2 - Background: In general, most clinical studies have long recruitment periods. Signing the informed consent is particularly time-consuming when the participant must meet physically with the researchers. Therefore, introducing fully web-based techniques with the use of eAuthentication (BankID) and new digital electrocardiogram (ECG) monitoring could speed up inclusion time, increase adherence, and also reach out to more remote regions. Objective: The objectives of this study were to explore whether inclusion of a large number of participants could be realized quickly by using a total digital approach both for information and signing of informed consent, along with ECG monitoring and instant feedback on a mobile device. We also explored whether this approach can increase adherence in registration of ECG recordings and answering questionnaires, and if it would result in a more geographically uniform distribution of participants covering a wide age span. Methods: Women with palpitations were intensively studied over 2 months by means of a handheld ECG monitoring device (Coala Heart Monitor). The device connects to a smartphone or tablet, which allows the participants to obtain the results immediately. Recruitment, study information, and signing the informed consent form with the help of BankID were performed in a completely digital manner. Results: Between March and May 2018, 2424 women indicated their interest in participating in the study. On June 19, 2018, presumptive participants were invited to log in and register. After 25 days, 1082 women were included in the study; among these, 1020 women fulfilled the inclusion criteria, 913 of whom completed all phases of the study: recording ECG using the handheld device, completion of the prestudy questionnaires, and completion of the poststudy questionnaires 2 months after the ECG recordings. The dropout rate was 9%. In total, 101,804 ECG recordings were made. The mean age was 56 (SD 11) years (range 21-88 years) and 35 participants were 75 years or older. The participants were evenly distributed between living in the countryside and in cities. Conclusions: Total digital inclusion recruitment of 1082 participants was achieved in only 25 days, and resulted in a good geographical distribution, excellent adherence, and ability to reach a vast age span, including elderly women. Studies using a total digital design would be particularly appealing during a pandemic since physical contact should be avoided as much as possible. Trial Registration: ISRCTN Registry ISRCTN22495299; http://www.isrctn.com/ISRCTN22495299 UR - http://formative.jmir.org/2021/2/e18385/ UR - http://dx.doi.org/10.2196/18385 UR - http://www.ncbi.nlm.nih.gov/pubmed/33599617 ID - info:doi/10.2196/18385 ER - TY - JOUR AU - Singh, Aniruddha AU - Mountjoy, Natalie AU - McElroy, Doug AU - Mittal, Shilpi AU - Al Hemyari, Bashar AU - Coffey, Nicholas AU - Miller, Kristen AU - Gaines, Kenneth PY - 2021/1/22 TI - Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study JO - JMIR Cardio SP - e25074 VL - 5 IS - 1 KW - COVID-19 KW - telehealth KW - cardiology KW - internet KW - broadband KW - patient satisfaction KW - restriction KW - survey N2 - Background: The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. Objective: This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. Methods: We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. Results: A total of 224 respondents began our survey (11% of our sample of 2019 patients). Our recruitment rate was 86% (n=193) and our completion rate was 62% (n=120). The no-show rate for telehealth visits (345/2019, 17%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63%) cited not being aware of their appointment as a primary factor, and 15 (47%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0% (35/106) of respondents. Conclusions: This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits. UR - http://cardio.jmir.org/2021/1/e25074/ UR - http://dx.doi.org/10.2196/25074 UR - http://www.ncbi.nlm.nih.gov/pubmed/33385234 ID - info:doi/10.2196/25074 ER - TY - JOUR AU - Kramer Freeman, Linda AU - Richards, Keith AU - Conti, B. Jamie AU - Sears, F. Samuel PY - 2017/09/26 TI - Patients With Implantable Cardioverter Defibrillators on Social Media Report More Shock Anxiety Than Clinic Patients: Results From an Online Survey JO - JMIR Cardio SP - e6 VL - 1 IS - 2 KW - health communication KW - social media KW - implantable cardioverter-defibrillator KW - cardiology patients KW - shock anxiety N2 - Background: Coping with heart disease and the potential for implantable cardioverter defibrillator (ICD) shocks challenges the psychological adjustment of patients with ICDs. Social media use may be used to seek education and support from others. Objective: The aim of this study was to examine the content of information sought online and whether a social media sample of patients with ICDs report more device-specific anxiety than clinic-based normative samples. Methods: A total of 196 participants were recruited via social media messages and invited to complete an online survey. Results: It was found that the information most often sought by online users (62.4%, 123/196) involved both emotional support (eg, gaining emotional support from other patients with ICDs) and technical information (52.6%, 103/196) (eg, dealing with magnetic interference). The online sample reported more shock anxiety than a typical clinical sample with mean values of 22.75 (SD 10.06) and 15.18 (SD 6.50), respectively (P<.001). Conclusions: Collectively, these results suggest that patients with ICDs that are online are seeking emotional information and support, and that they report increased shock anxiety relative to typical clinic-based patients. Future research should examine how online information and clinical-based information form a composite understanding and adjustment for patients ICDs. UR - http://cardio.jmir.org/2017/2/e6/ UR - http://dx.doi.org/10.2196/cardio.8152 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758785 ID - info:doi/10.2196/cardio.8152 ER -